Systems and methods for selective targeting of structural features in treating skin conditions

ABSTRACT

Systems and methods are provided for locating anatomical features in the skin based on analysis of reflected light, and treating the located anatomical features using high-energy light. A labeling agent can be administered to optically differentiate the anatomical feature.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a U.S. Continuation Application of U.S. patentapplication Ser. No. 16/078,773 filed Aug. 22, 20219 which representsthe U.S. National Stage of International Application No.PCT/US2017/018874, filed Feb. 22, 2017, which claims the benefit of U.S.Application Ser. No. 62/298,227, filed Feb. 22, 2016, and entitled“Novel Method for Treatment of Hyperhidrosis by Labeling Sweat GlandsFollowed by Selective Targeted Ablation by a Smart Laser,” and U.S.Application Ser. No. 62/442,690, filed Jan. 5, 2017, and entitled“Systems and Methods for Selective Targeting of Structural Features inTreating Skin Conditions.” The disclosure of each of the above-citedapplications, as well as any references cited therein, is herebyincorporated by reference.

FIELD OF THE INVENTION

This document concerns an invention relating generally to locatinganatomical features in the skin using a labeling agent to opticallydifferentiate the features, and to the automated delivery of high-energylight to anatomical features located by analyzing light reflected fromthe skin, useful for such applications as the treatment of hyperhidrosisby the selective ablation of sweat glands via targeted application ofcoherent light.

BACKGROUND

Sweating (also known as perspiration, diaphoresis, or hidrosis) involvesthe secretion of fluids by sweat glands in the skin. Sweat glands arefound in the palms of the hands, soles of the feet, and underneath thearms (i.e., underarms or “armpits”), also known as the axilla. One ofthe primary functions of sweating is regulation of body temperature, asevaporation of sweat from the skin has a cooling effect. But sweatingcan reach excessive levels, and is considered to be abnormally high whenit is not necessarily related to increases in body temperature,exercise, or high levels of stress. Excessive sweat may soak throughclothing or drip off the skin and could disrupt normal daily activities.Abnormally high sweating can also result in social anxiety andembarrassment.

There are two main types of sweat glands in the skin: eccrine glands andapocrine glands. Eccrine glands, which can be found over the entirebody, with the highest density on palms of the hands and soles of thefeet, open directly onto the surface of the skin. When body temperaturerises, eccrine glands provide thermoregulation by secreting fluid ontothe surface of the skin for evaporative cooling. The fluid from eccrineglands is mainly water and salt. Apocrine glands, which are found in theaxillae, anogenital region, periumbilical region, nipples, and areolae,release sweat into the hair follicle before opening onto the skinsurface. Apocrine sweat glands produce a proteinaceous fluid that isitself odorless, but may become odoriferous once the proteins areingested by bacteria that are commonly found on the skin. A third typeof sweat gland, referred to as the apoeccrine, can be found in theaxillae and may play a role in thermoregulation.

Abnormally excessive sweating, which is known as hyperhidrosis and is acommon dermatologic complaint, frequently affects palms, soles, andaxillae, although other areas of the body may be affected as well. Onetreatment for hyperhidrosis involves use of (prescription-strength)antiperspirants with aluminum chloride on affected areas, but these onlyprovide short-term relief. Other treatments involve botulinum toxins,such as OnabotulinumtoxinA (commercially known as “Botox”), which isapproved for severe primary axillary hyperhidrosis, but such treatmentsrequire a large number of painful injections and must be repeated everyfew months. Another treatment, referred to as the “miraDry” system, isapproved for primary axillary hyperhidrosis, but the system suffers fromsignificant co-morbidity, including neuropathy and pain. Further,neither botulinum toxin nor miraDry is approved for treatment of areasoutside of the axillae.

SUMMARY

The present disclosure provides exemplary systems and methods forlocating anatomical features in the skin based on an analysis of lightreflected from an area to be treated, and applying a high-energy lightbeam (using, e.g., a treatment laser) to a fraction (or all) of thelocated anatomical features. A labeling agent may be administered to anarea of the skin to optically differentiate an anatomical feature ofinterest from its surroundings. If it does not spontaneously reach thefeatures of interest in an acceptable length of time without externalinfluence, the labeling agent may be induced towards, or otherwiseguided to, the anatomical features. The reflected light that is analyzedmay result from ambient light, or from light emitted by a floating spotlaser or other light source. A camera may be used to capture an image ofthe area of the skin to be analyzed before treatment, or the reflectedspot laser light may be detected using a scanner and analyzed. Thetreatment laser may be ablative (such as erbium or carbon dioxidelasers) or non-ablative (e.g., some fiber lasers), and may be used todisrupt a targeted anatomical feature. As a non-limiting example,disruption may include thermal ablation of an anatomical structure,promotion of a photoreaction, break down of plasma, damaging ofindividual cells, vaporization of tissue, and the like. In someconfigurations, exemplary versions may be applied to treatinghyperhidrosis or otherwise targeting glands with a thermally-ablativelaser. The foregoing and other aspects and advantages of the inventionwill appear from the following description. In the description,reference is made to the accompanying drawings which form a part hereof,and in which there is shown by way of illustration one or more preferredembodiments of the invention. Such embodiments do not necessarilyrepresent the full scope of the invention, however, and reference ismade therefore to the claims for interpreting the scope of theinvention.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows an exemplary system for locating structural features in theskin and applying laser light thereto.

FIG. 2 provides a series of steps involved in an exemplary method forlocating structural features of interest and applying a laser lightthereto.

FIG. 3A shows a (not-to-scale) sweat gland as an example of a structuralfeature that could be located and treated using the exemplary system andmethod of FIGS. 1 and 2 , respectively. After iontophoresis, the bluelabeling of the pores is depicted by shading in FIGS. 3A and 3B. FIG. 3Balso shows an exemplary mapping, with x-y coordinates of irregularlyspaced blue dots. The coordinates can be passed to an automatedcontroller of a treatment laser system.

DETAILED DESCRIPTION

The following discussion is presented to enable a person skilled in theart to make and use exemplary configurations of the invention. Variousmodifications to the illustrated configurations will be readily apparentto those skilled in the art, and the generic principles herein can beapplied to other configurations and applications without departing fromthe invention. Thus, configurations of the invention are not intended tobe limited to versions shown, but are to be accorded the widest scopeconsistent with the principles and features disclosed herein. Thefollowing detailed description is to be read with reference to thefigures. The figures depict selected configurations and are not intendedto limit the scope of the invention. Skilled artisans will recognize theexamples provided herein have many useful alternatives that fall withinthe scope of configurations of the invention.

The invention may be described herein in terms of functional and/orlogical block components and various processing steps. It should beappreciated that such block components may be realized by any number ofhardware, software, and/or firmware components configured to perform thespecified functions. For example, different configurations may employvarious integrated circuit components, e.g., memory elements, digitalsignal processing elements, logic elements, diodes, look-up tables,etc., which may carry out a variety of functions under the control ofone or more microprocessors or other control devices. Otherconfigurations may employ program code, or code in combination withother circuit components. It should also be appreciated that certaincomponents and functions may be shared and/or shuffled between blocksand among blocks in different versions of the invention, as deemedsuitable.

Referring to FIG. 1 , an exemplary laser treatment system 100 includes acontroller 105 for directing the overall functionality of the system.The controller 105 includes a processor, and memory with instructions(i.e., executable code in the form of software, firmware, etc.) to beexecuted for controlling the operations of the system 100. A display 110(which may be a touchscreen) is used to provide prompts, images, etc.,and a user interface 115 (which may include a mouse, keyboard, stylus,touchscreen, etc.) is used to receive commands from a user. The system100 includes a photo instrument 130, which may include one or more of acamera and a scanner with a photosensor, for receiving light reflectedoff the area of the skin to be treated. In certain configurations, afloating spot laser 135 (or other light source) may be included to emita light directed at the skin, with its reflection being received at thephoto instrument 130. In other configurations, the system 100 may(alternatively or additionally) capture images of the skin (formed usingthe reflection of ambient light off the skin) with a camera.

Any suitable treatment laser 140 (or other light source) may be used.For example, the treatment laser 140 may emit high-energy light, such asin the infrared range (such as a laser used to emit highly coherentlight). An analyzer 120 is used, in a general sense, to analyzeattributes of light reflected off the skin. This may include imageprocessing of images captured using a camera, or evaluation ofattributes (such as wavelength) of reflected light. An actuator 125 maybe used to adjust the position of the spot laser 135 and/or thetreatment laser 140. In certain configurations, the two light sourcesmay be immovably secured to each other such that, e.g., they target thesame spot on the skin. The actuator 125 may also be used to adjust theposition of the photo instrument 130. It is noted that the actuator maybe any mechanism that is able to move one or more components of system100 in various ways, powered electrically or otherwise, using, e.g.,motors, magnetic manipulation, etc.

In certain configurations, a light source for detection (such as spotlaser 135) and a light source for treating (such as treatment laser 140)may be “co-registered” or “co-axial” so that the detection light source(and associated reflected light from the skin) can be used to detect atarget, and the treating light source can be (immediately) triggered tofire at the same location. Reducing the delay between the time thereflected light from the spot laser 135 is received at the photoinstrument 130, and the time the treatment laser 140 is fired at thetarget, reduces the likelihood that, for example, a subject will movethe body part being treated, or the target is otherwise relocated.

In alternative configurations, the detection light source can beactuated/aimed independently from the treatment light source (or the twolight sources can otherwise be aimed at different locations fixedrelative to each other) to allow the two light sources to have differenttargets. This can be used, for example, in situations in which it isdesirable to allow a spot laser to locate a subsequent target to betreated while the treatment laser is treating a current target, or toallow the spot laser to confirm the “post-treatment” state of analready-treated target to evaluate, for example, whether the treatmentlaser should subsequently be re-aimed at the previous target foradditional treatment. If, in certain configurations, multiple spotlasers are included, one spot laser may reflect light to locate the nexttarget, and another spot laser may reflect light at a treated target toevaluate the target or the results of the treatment, and determinewhether results were satisfactory or whether retreatment is warranted.

It is noted that although FIG. 1 shows one of each component (e.g., oneactuator 125, one photo instrument 130, one spot laser 135, and onetreatment laser 140), there may be two or more of each component. Forexample, multiple actuators may be provided, each associated withvarious motions, positions, and light sources. Similarly, multiple spotlasers may be provided to facilitate, for example, simultaneousevaluation of multiple locations. And multiple photo instruments may beincluded, for example, to receive reflections from different sources. Itmay be, for example, that identification of targets are more accurate incertain applications if light is directed at a suspected target frommultiple angles, and the multiple reflections detected and analyzed tolocate features of interest. With one spot laser, light may be emittedat a suspected target from one angle, and the spot laser relocated toemit light at the suspected target from a second angle. This couldsignificantly increase the delay between identification/confirmation ofa target (in large part due to the time taken to actuate and re-aim thespot laser), and the application of light from a treatment laser. Havingmultiple spot lasers could decrease this delay between targeting andtreatment. Moreover, multiple treatment lasers may be provided to enablesimultaneous treatment of multiple targets. This may be particularlyadvantageous if the number of targets to be treated is in the thousands,and the overall treatment time is to be reduced.

In some configurations, exemplary versions may be applied to treatinghyperhidrosis or otherwise targeting sweat glands with athermally-ablative laser. The locations of sweat glands in the skin arenot readily apparent from observations of the skin with the naked eye.Although they are fairly close together, sweat pores are spacedirregularly throughout the skin. To enhance accurate targeting of thesweat glands, as distinguished from surrounding tissue, sweat glands maybe “marked” as targets for ablation. In certain implementations, alabeling agent, such as methylene blue, may be used to stain sweatglands to be targeted using iontophoresis. The target is, for example,the skin pore through which the eccrine sweat gland emits sweat. Themethylene blue is selectively “taken up” at the surface of the pore toform a blue dot. Iontophoresis of methylene blue results in “sweat porepatterns” but does not result in the presence of methylene bluethroughout the gland. Rather, the methylene blue is limited to theportion of the eccrine sweat gland in the epidermis, otherwise known asthe acrosyringium (see also FIG. 3A, discussed below).

A camera, integrated with a laser hand piece, may be used to photographthe pore pattern. Image feature recognition is used to locate thecenters of the dots on a grid (e.g. a Cartesian grid) for targeting. Thecoordinates of these target points are then passed to the computer thatcontrols the treatment laser. The treatment laser is then actuated sothat the laser aperture targets desired coordinates. An ablativewavelength (e.g. erbium at 2940 nanometers (nm) or C0₂ at 10,600 nm) canthen be used to drill a vertical hole through the skin at the desiredlocation at a desired depth. The laser beam will ablate theacrosyringium and a portion of (or all of) the ductal portion of theeccrine apparatus, possibly even extending all the way to the secretorycoil. The laser beam will be no wider than 500 microns, and in certainconfigurations, a narrower beam with a diameter of 75-200 microns may bepreferable, so that the ductal portion of the eccrine apparatus (thewidth of which is 40-80 microns) will be ablated without undesired orexcessive damage to surrounding skin. After the initial “hole” isdrilled (i.e., once a column of tissue containing the eccrine gland isvaporized), a controller can then automatically target the treatmentlaser at a second target, and fire the narrow ablative beam to drill asecond hole. Alternatively or additionally, labeled sweat glands can belocated by emitting light from a floating spot laser, and detecting thereflection of that light. Based on attributes of the reflection (such aswavelength), the positions of the labeled sweat glands can bedetermined.

Exemplary configurations are well-suited to targeting anatomicalfeatures that are microscopic, that do not have pigmentation or otheroptically-distinguishing features, and/or are very numerous (e.g., inthe thousands) such that manual targeting is not practical. The laserlight may be used to bring about a desired result, not limited toablation. For example, the light may be used to initiate, promote, orinduce a photochemical reaction (for applications related to, forexample, oncology, surgery, tissue engineering, etc.). In yet otherconfigurations, light may be used to, for example, break down plasma,damage or disrupt individual or groups of cells, vaporize tissue, etc.In addition to hyperhidrosis, an ablative approach can be useful for,e.g., targeting sebaceous glands in the treatment of acne, removal ofwhite (or otherwise with little pigment) hair, etc.

Referring to FIG. 2 , an exemplary process 200 may begin withadministration of a labeling agent (205) to an area of the skin to betreated. The labeling agent is intended to optically distinguish ananatomical feature of interest (such as a sweat gland). A high-contrast(and biologically inactive) dye, such as methylene blue, may be asuitable labeling agent to target, for example, sweat glands in theskin. In other situations, the labeling agent may be, e.g., metallicnanoparticles (such as gold nanoparticles for labeling the orifice ofsebaceous glands, which have lipid-rich secretions and are associatedwith acne), or may be a drug or other chemical which itself may noteffectively “label” a targeted feature, but may be metabolized or mayreact with other chemicals (which may be already present in the skin, orwhich may also be administered to the skin) to yield a metabolite orchemical product that is able to photo-distinguish the features ofinterest. For example, administering aminolevulinic acid (ALA) to cellscan yield porphyrin with fluorescent properties (in about 30 minutes to2 hours).

The administered labeling agent may itself reach the targeted feature ina given amount of time (210). In certain situations, the labeling agentmay need to be “guided” to the features of interest (at least to reachthem in an acceptable amount of time), in which case the labeling agentmay be induced to the targeted anatomical features (215). For example,methylene blue, which is a cation (i.e., positively charged), may beguided to sweat glands using iontopheresis (by placing an anode (i.e.,positive electrode) on the skin). By applying a low-level electriccurrent, the methylene blue travels to the duct of the eccrine gland,staining part of the gland. For other labeling agents, such as goldnanoparticles, an intense vibration applied via ultrasound may be usedto guide the nanoparticles to the anatomical features of interest (whichmay be effective when the labeling agent, in a sense, needs to “swimupstream” to get to the targets).

The area of the skin being treated may be imaged (220) using a camera,and the image may be analyzed (230) to locate the labeled features.Methylene blue, as one non-limiting example, has a distinct absorptionspectrum, absorbing light very well at 670 nm (in the red part of thespectrum) and having a blue appearance. By contrast, melanin in the skinabsorbs blue and near infrared light. The system may thus capturewavelengths (1) that are absorbed by both methylene blue and melanin,and (2) that are absorbed by melanin but not by methylene blue, and inimage processing, subtract the melanin signal (2) from the combinationsignal (1) to identify the methylene blue. Methylene blue isadvantageous because there are no blue features natively found in theskin. This allows for strong absorption contrast—i.e., high reflectanceof skin where eccrine ducts are not, and low reflectance where the ductsare stained with methylene blue, resulting in blue “dots” that haveexcellent contrast.

An additional processing technique involves thresholding to, forexample, minimize shadowing effects (depending on how the skin isilluminated) resulting from such features as wrinkles in the skin. Thismight use (for example) spectral (i.e., wavelength-dependent) processingif multiple wavelengths are involved, or processing the color channelsof an RGB camera—in which case the red (R) channel of pixels will havecontrast information for methylene blue, and the blue (B) and green (G)channels will have high-contrast information for melanin but notmethylene blue—by, e.g., subtracting (or taking a ratio) of the signalsfrom the different channels. Separating the channels can thus be usefulfor distinguishing methylene blue (or other labeling agents) fromsurrounding features. Additionally, a pixel intensity threshold fordiscriminating dark spots can also help enhance discrimination. Thisprocessing can provide a “bitmap” with regions of identified pixelsassociated with the eccrine duct apparatus.

Spatial filtering can also be used to provide criteria to help targetfeatures falling within a certain (expected) range of sizes for thefeatures of interest (approximately 50 microns for eccrine ducts). Forexample, by requiring a certain minimum number of adjacent pixels, butno more than a maximum number, the system could reduce the number offalse positives (i.e., firing a laser at locations without the featureof interest). A spot that is too small (e.g., a single pixel) could bedue to, e.g., unintended labeling of a feature that is not beingtargeted, or to error/noise, and firing a laser at such a spot may thusablate or treat otherwise normal regions. Similarly, treating a spotthat is too big (i.e., beyond the range of expected sizes for thefeature of interest, such as 100 microns in the case of eccrine glands)could also apply excessive laser light at surrounding (otherwise normal)areas of the skin.

Alternatively or additionally, a spot laser may be used to emit light atthe skin, and the reflected light detected (225) using, e.g., a scanneror other photosensors. The reflected light may then be analyzed (230) insimilar fashion by determining attributes (such as wavelengths) of thereflected light. Based on the analysis, it can be determined whether any(untreated) features of interest have been located (235). If so, anoptical treatment can be delivered. For example, a laser may deliverhigh-energy light. Thus, the treatment may be effectuated using a laseraimed (using, e.g., an actuator) at one or more targets at a time (240).The emitted light may be in the infrared range. Once the treatment laserhas fired, energy is delivered to the location of the anatomicalfeatures to effectuate the treatment, which may include treating, suchas disrupting the anatomical features (or a physiological functionthereof). As described, treatment may include thermal ablation,promotion of a photoreaction, break down of plasma, damaging ofindividual cells, vaporization of tissue, and the like. In the describedexample of the anatomical features being a gland, as a non-limitingexample a sweat gland, the treatment may cause the secretion of sweat tobe inhibited or reduced. After treatment of a particular spatiallocation or targeted anatomical feature, the system can determinewhether there is another (already-located) untreated feature to betargeted (235) in an available image, and re-aim the laser at the otherfeature (240). Alternatively, the system can capture another image (220)for analysis (useful in case changes in the skin warrant, for example,re-application with a relatively-lower intensity laser beam), or emitlight with the floating spot laser (225) to identify the next anatomicalfeature to be targeted (if any).

The use of a floating spot laser provides certain advantages, such asenhancing the ability of the system to scale up and down more easily fordifferent fields of view. With an imaging system (which uses a camera tocapture an image of the area to be treated), once a feature of interesthas been located, the treatment laser is lined up with the relevantpixels in the image. However, because a patient might move after theimage is taken but before the treatment laser fires, the laser might“miss” or the system might otherwise make an alignment error. With afloating spot laser that is aligned with a treatment laser, such thatboth target the same spot, the system can, in a sense, provide more“real time” treatment. That is, the location that is identified ashaving a label is the same location that is targeted by the treatmentlaser, and once a feature is suitably targeted, the treatment laser can(virtually simultaneously) be fired at that same location off of whichthe spot laser light reflected.

On the other hand, an advantage of having an imaging system is theability to provide an image of the area being treated for review by ahealthcare provider. For example, in the process 200 of FIG. 2 , beforethe firing step (240), the system 100 may provide a doctor with thecaptured image showing a spot that is to be treated on display 110. ACartesian grid (see FIG. 3B) may be overlaid on the image, or the spotto be treated otherwise indicated on the display (with, e.g., an arrowto the spot, a box/circle around the spot, placing the spot in focusrelative to (out-of-focus) surroundings, “graying” out surroundingsand/or brightening the spot to be treated relative to its surroundings,etc.). The practitioner may then confirm that treatment should beapplied at the indicated spot via user interface 115 (e.g., by touchinga confirmation icon on a touchscreen). Moreover, an imaging systemapproach might be easily adaptable to detection of a relatively greatervariety of structural features of the skin.

Referring to FIG. 3A, an area of the skin 10 is represented withepidermis 12, dermis 14, and subcutaneous fat 16. The skin thickness(epidermis and dermis) can range from 0.5 to 4 millimeters (mm),depending on body site. Three eccrine glands 20, 30, 40 are alsoillustrated. Gland 20, which is in a pre-labeling state, includes an(un-labeled) acrosyringium 22, a duct 24, and a secretory coil (notshown), which may be in the lower dermis 14 or the subcutaneous fat 16.Gland 30, following the step of labeling or marking (such as by usingmethylene blue) but prior to treatment, includes a portion of theacrosyringium 32 labeled with methylene blue (as represented by the grayshading). Gland 40, following application of a laser beam, shows anablated region 42. The depth of ablation, which can be adjusted byvarying the type of laser used or the duration or intensity of thelaser-light application, is selected so as to cripple or disrupt theeccrine gland. Ablation would encompass the dermal portion of the gland(duct and secretory coil, if located in the lower dermis 14), butablation depth can also be increased to include a portion of thesubcutaneous fat 16 (where the secretory coil may be located). Suitableablation depths may range from 1 to 4 mm, and can depend on location inthe body/skin. FIG. 3B represents an area 50 of the skin to be treated,with (blue) “spots” 52 representing labeled ostia (openings) of theacrosyringium. The system can identify locations of labeled sweat glandsaccording to a Cartesian grid with horizontal lines 54 and verticallines 56. As shown in FIG. 3B, the x-y coordinates of gland 52 are (x=8,y=3).

The exemplary laser-guided robotics described above is well-suited tosupravital targeting of anatomical structures such as glands (e.g.,sweat glands), as discussed above, as well as other anatomicalstructures. For example, even without the introduction of a labelingagent, lipid-selection absorption can be useful to target, for example,sebaceous glands. This is due to the difference in absorption spectrafor water and lipids (i.e., 1210 nm versus 1190 nm). The system isparticularly advantageous for treating densely-packed or otherwisenumerous anatomical structures (with, e.g., hundreds to millions oftargets).

Exemplary systems are configured to be highly spatially selective. Theymay be configured, for example, to disrupt the physiological function of“targets” (cells, tissues, tumors, growths, organs, etc.) to a desiredlevel—such as the secretion of fluids by glands in the skin—withoutcausing any undesired or collateral damage to other anatomical featuresor to surrounding tissue. To effectuate the disruption permanently orindefinitely—or temporarily if disruption for a duration of time isdeemed acceptable, and/or if permanent disruption is deemed harmful orotherwise undesirable—the targeted anatomical features may need to bedamaged, destroyed, or vaporized to varying degrees. The parameters ofthe treatment can thus be set, depending on the characteristics of theparticular target and its surroundings, so as to achieve the desiredresult on (i.e., “treat”) only the desired targets with minimal impacton surrounding features. Different anatomical features can beselectively targeted by adjusting, for example, the parameters of thelight delivered, such as wavelength, diameter (of the beam), intensity(i.e., power per unit area), type (of light source), etc. If, forexample, a lower-powered, narrower beam will effectuate the desiredoutcome with minimal impact on other tissue, it will generally bedesirable over a higher-powered, wider beam.

Other parameters that can be adjusted include duration of treatment. If,for example, a target requires application of a treatment laser for ashorter or longer duration before surrounding tissue is affected, theduration can be adjusted accordingly. In certain situations, it may bemore effective to apply multiple instances of light for shorterdurations instead of one instance for a relatively longer duration.Similarly, if multiple instances of light are to be applied, dependingon the nature of the targeted feature and/or its surroundings, eachinstance may have the same lower power intensity, and/or the powerintensity may be progressively decreased (or increased) after the firstinstance. Moreover, duration and power intensity can be adjusted up ordown between instances as deemed appropriate depending on a re-imagingof a treated location. This can be particularly advantageous whenanatomical structures of the same type are expected to significantlyvary in resiliency/robustness among different subjects, and even in thesame subject depending on location on body and/or natural variability.Consequently, it may be that the first instance is at the (relatively)lowest power intensity and for the shortest duration, and intensityand/or duration are increased only after a re-evaluation of lightreflected from a treated spot indicates that a greater intensity will beneeded to achieve the desired result.

The effects of each instance of light application on a given anatomicalstructure may be evaluated by, for example, observing the size,intensity, wavelength, etc., of a labeled spot. For example, if thelabeling agent is vaporized proportionally with the target, then anobserved reduction in the size of the spot may be positively correlated,or otherwise correspond, with the damage imparted on the structure.Additionally, the labeling agent may be selected such that it changesupon application of the light (through, e.g., photoreaction). The typeand degree of change in the labeling agent as a result of theapplication of light can be correlated with how much treatment reachedthe intended target (as opposed to surrounding tissue), or with theimpact/effect of the light on the anatomical structures. Accordingly,evaluating changes in the characteristics of the (remaining) labelingagent can inform the treatment parameters of subsequent instances oflight application.

Moreover, different specific portions of marks/labels can be targeteddepending on the structure or the nature of the labeling agent. Forexample, although the center of a spot will often be the center of thetarget, and firing at its center may help ensure that most of the impactwill be on the structure and not its surroundings, in certainsituations, firing at the periphery of a “spot” may have a moredesirable outcome depending on, for example, what portion of theanatomical structure is more responsible (relatively) for thephysiological function to be disrupted, or depending on what is“beneath” the labeled structure, or on what portion of the structure orits surroundings receives more of the labeling agent. For example, thelabeled “spot” may be associated with an adjacent structure, or aperiphery or side of the feature of interest, and the center of the spotmay not be the center of the targeted feature, requiring an adjustmentto the aim of the laser. In certain situations, depending on (forexample) the target and the labeling agent used, it may be the case thattargeting the structure that is labeled will not be as effective (if atall) as targeting another (unlabeled) location adjacent to the labeledstructure (or otherwise a known distance away nearby). That is, it ispossible that the labeling agent will be taken up not by the ideal ordesired target for bringing about a desired result using the treatmentlaser, but the optically-differentiated labels may instead “indirectly”mark the locations that should be targeted for receiving laser light.

The present invention has been described in terms of one or morepreferred configurations, and it should be appreciated that manyequivalents, alternatives, variations, additions, and modifications,aside from those expressly stated, and apart from combining thedifferent features of the foregoing versions in varying ways, can bemade and are within the scope of the invention. It should be appreciatedthat the invention is applicable to other procedures and to achieveother objectives as well. For example, it should be appreciated that theabove systems and methods can be implemented using hardware, software,single integrated devices, multiple devices in wired or wirelesscommunication, or any combination thereof. Such changes are not to beconstrued as describing the only additions and modifications to theinvention. It is expressly contemplated that any of the processes orsteps described herein may be combined, eliminated, or reordered.Accordingly, this description is meant to be taken only by way ofexample, and not to otherwise limit the scope of this invention. Thepatentable scope of the invention is defined by the claims and mayinclude other examples that occur to those skilled in the art.

What is claimed is:
 1. A method for targeting anatomical features inskin, the method comprising: analyzing, using one or more processors,light reflected from the skin to locate the anatomical features, eachspatial location of each anatomical feature being opticallydifferentiated from surrounding skin; and sequentially targeting acoherent light source at the located anatomical features and deliveringcoherent light thereto, wherein the coherent light has a width less than500 microns.
 2. The method of claim 1, wherein analyzing light reflectedfrom the skin includes: acquiring imaging data from the light reflectedby the skin; and locating the anatomical features using the imagingdata.
 3. The method of claim 2, further comprising: thresholding theimaging data to at least one of: generate wavelength dependent imagingdata; minimize shadow effects; or discriminate dark spots.
 4. The methodof claim 2, further comprising restricting the located anatomicalfeatures based on a size, and wherein the size corresponds to anexpected size of the anatomical features.
 5. The method of claim 1,wherein the anatomical features are at least one of: a gland; a sweatgland; a sebaceous gland; or a hair.
 6. A method for targetinganatomical features in skin, the method comprising: analyzing, using oneor more processors, light reflected from the skin to locate theanatomical features, each spatial location of each anatomical featurebeing optically differentiated from surrounding skin; sequentiallytargeting a coherent light source at the located anatomical features anddelivering coherent light thereto; and comprising confirming, via a userinterface, that coherent light be delivered to each anatomical feature,prior to delivery of the coherent light to each anatomical feature.
 7. Acomputer implemented method for targeting anatomical features in skin,the method comprising: receiving, using one or more processors, imagingdata from a photo instrument of light reflected from the skin;analyzing, using the one or more processors, the imaging data to locatethe anatomical features; generating, using the one or more processors,at least one of: an image displaying spatial locations of each of thelocated anatomical features; or a grid displaying the spatial locationsof each of the located anatomical features, and wherein the spatiallocations are the locations where coherent light is to be delivered; anddelivering, using the one or more processors, coherent light to each ofthe located anatomical features to disrupt a physiological function ofeach of the located anatomical features or vaporize a portion of each ofthe located the anatomical features.
 8. A computer implemented methodfor targeting anatomical features in skin, the method comprising:receiving, using one or more processors, imaging data from a photoinstrument of light reflected from the skin; analyzing, using the one ormore processors, the imaging data to locate the anatomical features;generating, using the one or more processors, at least one of: an imagedisplaying spatial locations of each of the located anatomical features;or a grid displaying the spatial locations of each of the locatedanatomical features, and wherein the spatial locations are the locationswhere coherent light is to be delivered directing, using the one or moreprocessors, first coherent light from a coherent light source at a firstlocated anatomical feature prior to directing the first coherent light,confirming, using the one or more processors, that the first coherentlight be directed at the first located anatomical feature; directing,using the one or more processors, second coherent light from thecoherent light source at a second located anatomical feature; and priorto directing the second coherent light, confirming, using the one ormore processors, that the second coherent light be directed at thesecond located anatomical feature; and wherein the first locatedanatomical feature is different than the second located anatomicalfeature.
 9. A system for targeting anatomical features in skin, thesystem comprising: a laser configured to emit coherent light atanatomical features in the skin; a controller having a processor and anon-transitory memory with instructions executable by the processor,upon executing the instructions, the controller being configured to:cause the laser to direct first coherent light having a width less than500 microns at a first anatomical feature, the first coherent lightdelivered to the first anatomical features with operational parametersconfigured to at least one of: ablate a portion of the first anatomicalfeature; disrupt a physiological function of the first anatomicalfeature; or vaporize a portion of the first anatomical feature.
 10. Thesystem of claim 9, wherein the controller is further configured to causethe laser to direct second coherent light at a second anatomicalfeature, the second anatomical feature being different than the firstanatomical feature.
 11. The system of claim 10, wherein the secondcoherent light has a width less than 500 microns.
 12. The system ofclaim 9, further comprising a photo instrument configured to receivelight reflected by the skin of the subject, and wherein the controlleris further configured to: acquire, using the photo instrument, imagingdata; locate, using the imaging data, the first anatomical feature. 13.The system of claim 12, further comprising a light source configured todirect light at the skin of the subject, and wherein the imaging data isacquired by the photo instrument receiving light reflected off the skinof the subject that has been delivered by the light source.
 14. Thesystem of claim 13, wherein the treatment laser and the light source areat least one of co-registered, or co-axial.
 15. The system of claim 13,wherein the photo instrument is a first photo instrument, and the lightsource is a first light source, and further comprising: a second photoinstrument configured to receive light reflected by the skin of thesubject, and a second light source configured to direct light at theskin of the subject.
 16. The system of claim 9, wherein the laser is afirst laser, and further comprising a second laser configured to emitcoherent light at anatomical features in the skin, and wherein thecontroller is further configured to cause the second laser to directsecond coherent light at a second anatomical feature.
 17. The system ofclaim 16, wherein the first laser emits the first coherent light and thesecond laser emits the second coherent light simultaneously.
 18. Thesystem of claim 9, wherein the first anatomical feature is at least oneof: a gland; a sweat gland; a sebaceous gland; or a hair.